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    The "ACT-ive" pursuit of loss and gain : the impact of an acceptance and commitment therapy-based intervention on post weight-loss surgery individuals : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand
    (Massey University, 2021) Damnjanovic, Natalija
    Obesity prevalence continues to increase at an alarming rate worldwide and poses serious health risks to those affected including increased morbidity, mortality, and psychosocial consequences. Weight-loss surgery is currently the best evidence-based treatment for obesity yet, substantial postoperative weight regain is reported within 2-5 years. Successful weight management is complicated when longstanding psychological difficulties are present, that often require psychological input to address. In response, a private weight-loss surgery clinic has developed an Acceptance and Commitment Therapy-based (ACT) Intervention entitled the Foundations of Healthy Living (FOHL) Retreat with the aim of improving weight-loss surgery outcomes by providing greater support to individuals in the post-operative period. In this thesis, an exploration of the efficacy of the FOHL Retreat is conducted. A quasi-experiment pretest posttest non-equivalent control group design is utilised to investigate the impacts of the intervention on weight-related experiential avoidance, eating behaviour, and body mass index (BMI) over time. An additional supplementary exploration into participants’ relationships with food, eating, and their bodies pre- and post-surgically is undertaken using open-text response format questions. Those who attended the Retreat were also asked to share their perspectives on how their participation in the intervention affected their psychological wellbeing. The main findings of the study showed that the ACT-based intervention demonstrated significant effects on several of the variables of interest, in particular, disordered eating and BMI. These effects were mediated by improvements in weight-related experiential avoidance, suggesting the importance of focussing on targeting experiential avoidance as a key mechanism of change in positive postoperative psychological and weight outcomes. The qualitative component of this study expanded on these findings, identifying several key themes present in the experiences of individuals both prior to, and following, weight-loss surgery. Additionally, qualitative responses provided further insight as to the psychological changes participants experienced. Taken together, these findings highlight firstly, the importance of addressing the psychological needs of weight-loss surgery individuals, and secondly, the value of ACT in augmenting surgical outcomes. The results presented here also offer suggestions for further development and future dissemination of such interventions for this population.
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    Acceptance and commitment therapy : application in a real-world alcohol and other drug community setting : a thesis presented in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology, Massey University, Wellington, New Zealand
    (Massey University, 2018) Cotter, Rachel
    Treating addictive behaviours in alcohol and drug populations in real-world settings carries a range of issues: standardised treatment approaches have been criticised for their complexity and inaccessibility, their failure to retain clients over the course of therapy, and their inability to address the range of coexisting difficulties present. The development of transdiagnostic third wave therapies has recently emerged as an alternative to traditional approaches. One such therapeutic approach is Acceptance and Commitment Therapy (ACT). ACT has proven to be effective in the treatment of several mental illnesses such as anxiety disorders, mood disorders, psychotic symptoms, and personality disorders; it has been found to be effective with medical issues such as chronic pain, cancer, epilepsy, and weight loss; and, importantly, it has been applied across a variety of challenging conditions and evidence of its effectiveness in treatment of addictive behaviours is promising and growing. The current study aims to examine the effectiveness of a manualised ACT-based group treatment programme applied in a real-world Alcohol and Other Drug (AOD) community setting. It was hypothesised that ACT would lead to reductions in alcohol use, substance use and cravings, and common co-occurring symptomology such as anxiety and stress. It was also hypothesised that there would be an increase in mood management skills and mindfulness tendencies. Findings suggest ACT is a promising approach to treating AOD communities as it is well-regarded by clients and it elicits a reduction in several substance use behaviours; however, several outcomes were not statistically significant for many of the comparisons which is likely due to the study being underpowered. In addition, most coexisting problems reduced by post-group and improvements to mood management were evident. However, a rebound effect was found at the three-month follow-up in which the mood management skills reduced, and coexisting stress and anxiety increased. Mindfulness tendencies demonstrated an accumulative effect and showed significant increases by follow-up. These results, although not statistically significant, still provide support for future development and implementation of transdiagnostic approaches such as ACT, particularly in AOD services that commonly deal with dual diagnosis.
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    Development and evaluation of an ACT-based lifestyle education intervention for patients with pre-diabetes : a randomised controlled trial : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2019) Malthus, Sarah
    Type 2 diabetes is a potentially debilitating health condition, and rising prevalence rates of both diabetes and pre-diabetes (the precursor to diabetes) globally and in New Zealand has made prevention an important research focus. Early research indicated dramatic reductions in modifiable diabetes risks factors through the provision of lifestyle education interventions for those with pre-diabetes. However, the time and resource intensive nature of these interventions presented challenges for their implementation, and studies employing briefer more pragmatic interventions produced less compelling results. Incorporating a psychological component into lifestyle education interventions has been highlighted as a possible avenue for enhancing outcomes. This thesis describes the development/adaptation of two intervention approaches for patients with pre-diabetes; lifestyle education alone and lifestyle education combined with Acceptance and Commitment Therapy (ACT). The goal of the ACT/Education approach was to connect participants’ lifestyle goals to personally meaningful values, and equip them with skills to deal with difficult emotions that can function as barriers to goal attainment. A randomised controlled design was used to compare the effectiveness of these approaches with the provision of standard medical care. Results indicated the presence of significant cumulative intervention effects over time for HbA1c, BMI, waist circumference, saturated fat intake, life satisfaction, anxiety, and pre-diabetes knowledge; and education alone was more effective than standard care for reducing total cholesterol and waist circumference. However, results indicated that incorporating an ACT approach was no more beneficial than education alone or standard care across any of the outcome measures. Limitations related to statistical power, participant characteristics and methodology makes definitive interpretations of these results difficult. Addressing these limitations in future research may produce more meaningful outcomes.
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    Creating a compendium of third wave therapy strategies : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2018) Rous, Michelle Leanne
    Third Wave Cognitive Behavioural therapies have received much attention in the practice community recently. However, little has been done to understand how these therapies relate and diverge. Despite the varying theoretical models contributing to the Third Wave movement and their supposed varying therapeutic elements, studies have suggested that outcomes do not differ across these therapeutic approaches. This finding leaves room for the notion that shared or ‘common’ factors may be operating across these approaches. Exploration into common elements between these approaches is useful for identifying areas of overlap or uniqueness, shared processes of change, and perhaps components that may be particularly efficacious. Goldfried argued the best way to identify the commonalities among diverse therapeutic approaches is to compare them by their principles of change, or change processes (Goldfried, 1980). Research has investigated change processes for many approaches, including those of the Behaviour and Cognitive tradition. However, such extensive investigations have not been applied to the Third Wave approaches. Further, a lack of quality comparisons across these approaches, even at the more specific level of therapeutic strategies, represents a gap in the field. The present research first identified a set of strategies (84 items) within three Third Wave approaches: Dialectical Behaviour Therapy, Acceptance and Commitment Therapy and Mindfulness Based Cognitive Therapy. Strategies are sorted according to similarity in a card-sorting task, by two participant samples, a non-therapist sample (N=32) and a therapist sample (N=35). Sorting data were analysed using multidimensional scaling (MDS) to produce three three-dimensional models, representing each sample and a combined sample. The therapist sample was judged to represent the underlying relationships between strategies best. Three dimensions were identified that classified strategies according to their internal or external orientation; response to experience (accepting or exploratory in nature); and the perspectives involved (clients or external such as therapists). Additionally, 17 clusters were identified that comprised strategies perceived to represent similar concepts, five of which contained strategies from all three paradigms (Mindfulness; Noticing; Distress Tolerance and Acceptance; Therapist Style; and Observing and Perspective Taking). Commonalities and differences observed across the approaches are discussed and suggestions made for future validation of this model. Applications are discussed around informing investigations of change processes in the Third Wave and the integration of Third Wave therapy elements. This research presents opportunities for mapping strategies to various characteristics of the client, therapist or disorder, for example, and then identifying effective strategy use among these variables.